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Genetic Testing Fraud: A Concerning Trend

According to a white paper from the Healthcare Fraud Prevention Partnership, clinical laboratory services generated an estimated $87 billion in revenue in 2017. With so much money involved, laboratory services are an area at high risk for bad actors who want to take advantage of seniors.

A widespread scam

While Medicare strictly limits coverage for genetic screening tests, it does cover many genetic tests that meet the criteria for diagnostic tests such as those used to treat cancer and other medical conditions. A high-cost diagnostic test that can easily be marketed to the masses is a bright, shiny object to the health care con artist. There are numerous reports that scammers are using “fear factor” messaging to vulnerable seniors anxious to diagnose existing health concerns and proactively identify future medical conditions. This, along with legitimate interest in genetic tests, may help explain the rapid rise in genetic testing fraud across the nation.

The Senior Medicare Patrol (SMP) has seen a significant increase in complaints regarding genetic testing within the last year. The schemes range from complex kickback arrangements to criminals whose only purpose is identity theft. Most states have reported these schemes, noting health fairs, senior centers and apartments, farmers markets, church-sponsored wellness events, and malls as common locations for the scams to take place.

A variety of schemes

The individuals involved in these schemes range from unwitting providers to career con artists, and the scope covers a broad range of schemes, from medically unnecessary services to billing for services that were never provided. Providers, including physicians, may not even know that they are part of a fraud scheme. A current trend to watch is drug sensitivity testing, known as pharmacogenomics (occasionally termed “pharmacogenetics”). Pharmacogenomics is the testing of specific genes to gauge how patients will react to certain medications. Health care providers are interested in this type of service because it may reduce the risk of adverse drug events (ADEs). Seniors, especially Medicare beneficiaries, are often targeted in pharmacogenomic schemes because they may have a number of medical conditions that require several prescription medications. Physicians, anxious to avoid ADEs (and occasionally enticed by improper kickback payments), may order hundreds of pharmacogenomic tests well beyond the scope of the patient’s condition. Physicians may also be told by marketers that they can bill for interpreting the test results in order to maximize revenue. These are often billed under “physician interpretation of molecular pathology” codes. Unfortunately, these are all different versions of the same scam.

Medical information and identity theft

Of grave concern is the recent indication of medical identity theft associated with genetic testing fraud. Health fairs, senior centers, and telemarketing calls are high areas of risk for seniors vulnerable to the social skills of con artists. Victims are easily convinced to provide their health insurance and personally identifiable information with the enticing offer of free medical services. They may later find their health insurance was billed for thousands of dollars in medically unnecessary tests, or they may find that no testing was conducted and they are now the victim of identity theft.

It’s not just patients who may find themselves the victim of identity theft. There are currently reports that criminals are unlawfully using the names and logos of legitimate companies that offer genetic testing to further convince patients they’re being offered a real medical procedure as opposed to a scam. Be on the lookout for genetic testing fraud in an area near you.

To find answers or report potential fraud, errors, or abuse, contact your local Senior Medicare Patrol.

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About Jennifer Trussell

Jennifer Trussell is an Anti-Fraud Consultant, and recently retired from a distinguished 35-year career with the Federal government. Her previous positions with the U.S. Department of Health and Human Services – Office of Inspector General include Chief Investigator (OCIG); Senior Advisor to the Deputy Inspector General for Investigations; and Special Agent in Charge of the Investigations Branch. She began her law enforcement career in 1989 as an active-duty Special Agent with the Air Force Office of Special Investigations, and later served as a civilian Criminal Investigator for the U.S. Department of the Navy. Jennifer has a Master’s Degree in Policy Management from Georgetown University and a Bachelor’s Degree in Criminal Justice from Park University. She previously served on the Board of Directors for the National Health Care Anti-Fraud Association, and served on detail to the U.S. Senate Special Committee on Aging.

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